When healthcare systems form affiliations with non-owned physician practices or acquire independent groups, they often encounter difficulties in integrating those practices' electronic health records with those of other medical groups and of the healthcare organization itself. John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, thinks he has at least a temporary solution.

It isn't to "rip and replace" all of the ambulatory care EHRs with a single enterprise system. "That would create standardization, but it would also consume more capital than we have at a time when Meaningful Use Stage 2, ICD-10, and compliance requirements have already committed all available IT resources," he pointed out in a recent blog post.

Instead, he favors a modular approach that he calls "affiliation planning." This involves figuring out the workflows that the healthcare organization needs to support and then building upon the existing applications and infrastructure to automate those processes in ways that improve quality, safety and efficiency.

Among the technical means available to connect healthcare providers so they can coordinate care, he said, are Web-based viewers, health information exchange, registries/repositories, master patient indexes, and secure e-mail. None of these technologies is revolutionary, Halamka acknowledges, but together they can be used to build the connectivity needed to share key data.

Instead of simply working on each new project piecemeal -- an impossible task, considering the pace of change -- he suggested that organizations plan how they're going to integrate all of these systems ahead of time. At BIDMC, he said, his team is planning to take the following steps:

-- Have IT infrastructure and application managers list the services they had been asked to provide in the past when BIDMC formed new practice affiliations.

-- Get feedback from existing and new affiliated practices about their IT experience when they transitioned to BIDMC.

-- Create templates for affiliations, mergers and acquisitions. These templates should aid the IT department in rapidly developing staffing, capital and operating budget requests.

This rough-and-ready approach might serve as a Band-Aid in the current environment, but it meets only a small part of the challenge, observed Doug Hires, executive VP, sales, marketing and strategic services, for Santa Rosa Consulting, in an interview with InformationWeek Healthcare. "Halamka is advocating an approach that would solve some of the problems but doesn't solve the issue," he said.

That issue, which many CIOs are grappling with today, is how to share data across disparate systems within the clinical workflow. The best way to do that, in the view of Hires and other experts, is to construct an enterprise data warehouse capable of aggregating and normalizing discrete data from EHRs and other sources. Then the combined data can be fed back to physicians so they can view it in their EHRs.

One problem with Halamka's approach, Hires noted, is that it requires doctors to leave their workflow to get information. "We know that physicians hate having to hop over to a portal to look up specific clinical information," he pointed out. "When they do that, they have to write it down or print it out and go back to their own EHR."

He agreed with Halamka, however, that most organizations don't want to try to get all of the affiliated practices on their enterprise system. Not only would that be very expensive -- hospitals can provide up to 80% of the cost of EHR software to independent physicians, under the Stark rules -- but it would also run the risk of upsetting doctors who are happy with their current EHRs, he said.

This is an issue that has been plaguing health IT for awhile, and nobody has been able to find a solution everyone agrees to. Ipersonally like HiresG«÷ approach better as it would just require the informationto be in one data warehouse that would normalize data from different EHRsystems and feed them back to the physicians when needed. We all know thatphysicians hate taking extra steps such as having to go to a portal to accessthe patient information they need, so having the information in the EHR systemis crucial if we are ever going to find a solution to these issues.

The affiliation planning idea is a great idea. What seems to be lacking is a set of cookie-cutter solutions that organizations can leverage. Too many times organizations start out re-inventing the wheel.

May I also suggest a robust Data De-Identification solution that can consistently de-identify data across all members of an ACO (or HIE) without any PHI leaving any of the members. In this way the IT organizations can test with robust production-like data without the threat of a breach.

Healthcare data is nothing new, but yet, why do healthcare improvements from quantifiable data seem almost rare today? Healthcare administrators have a wealth of data accessible to them but aren't sure how much of that data is usable or even correct.